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<br />GM-12-14 <br /> <br />I:' <br />..J. <br /> <br />The date the Enrolling Unit received written notice from the Enrollee <br />for terminatlon I)f coverage, or the date requested by the Enrollee in <br />such riot ice, if later. <br /> <br />5. <br /> <br />The date Cln which the C,:,vered Pet'son moves CII.lt clf the Set'vice Area. <br /> <br />7. <br /> <br />The last <br />pens i oYled, <br />r'et i t'ed Or' <br />C'::\I'ltt'aci; . <br />p'r'ovi<;;ioYI <br />beneFits <br />l')i'",ge'r' be <br /> <br />day ,:;.f the last C.:mtt'act M')rlth the Em'()llee is 'r'et it'ed or <br />unless a specific coverage classification is specified for <br />pensioned individuals in the application attached to this <br />Medicat'e Eligible Em'.:,llees affQrded cl)verage under' this <br />must enroll in Parts A and B of Medicare and assign Medicare <br />to Health Plan or Health Plan Provider or the persQn will no <br />eligible and cQverage will termlnate. <br /> <br />8. <br /> <br />The end Qf the Contract Month in which the Covered Person ceases to be <br />eligible as art Em',:!llee 1Jt' Family Dependent, Qr ceases to be eligible <br />under the CQntinuation of CQverage OptiQn. <br /> <br />9. <br /> <br />On death of the CQvered PersQn unless the Continuation Qf Coverage <br />Option is requested. <br /> <br />10. <br /> <br />The date the Covered Family Dependent becQmes Medicare eligible and <br />does not enroll in Parts A and B of Medicare and assign Medicare <br />benefits to Health Plan Qr Participating Provider. <br /> <br />11. <br /> <br />Fot' a Family Dependent, the date the EnrQllee's coverage terminates <br />unless the Continuation of Coverage OptiQn applies. <br /> <br />12. <br /> <br />The date specified by the Health Plan after at least sixty (60) days <br />written notice to the Covered PersQn who fails to cooperate with the <br />Heal th Plan as specified in Sect ion X, "Pt'eVerlt ion of Medically <br />Harmfl.ll Use I:)f Services and Limitati.::ons Qn C,)verage Related Thereto. II <br /> <br />13. <br /> <br />I f any Covet'ed Pet'son permits the use of the Covered Person's <br />ident i ficat i':)1'1 card by any ':Jther persQn, such card may be confiscated <br />by Health Plan and Health Plan shall have the right to terminate the <br />Covered Person's coverage under this Contt'act provided it first gives <br />the CQvered PersQn at least sixty (60) days written nQtification Qf <br />such terminatiQn. <br /> <br />Misrepresentations <br /> <br />In the event the Enrolling Unit and/Qr a Covered Person shQuld include a <br />ft'audulerlt statement I:)t' any matet'ial mist'epresentatil:Jn ,::of fact in arl <br />em'l:)llmerlt applicat il)rl I)r Evidence ,::of Gcu:,d Health Statement submitted by Qr <br />on behalf Qf the Covered Person in order to secure coverage under this <br />Contract, such statement clr mist'ept'esentatil:ln shall be considered to void <br />the contract urlless the CQvered Person corrects incorrect infQrmatiQn <br />furnished t" Heal th Plar. and Health Plan has nQt t'el ied upon such incorrect <br />information to its prejudice. In addition, unless the misrepresentatiQn <br />made by a C,.)vered Pet'sc'n was ft'audulent Or' !.tnless it was matet'ial to the <br />risk assumed by Health Plan and cQntained in an enrQllment applicatiQn Or' <br />Evidence of GoQd Health Statement, a copy Qf which has been provided to the <br />CJvet'~d Per's,::o( , the above pt'l:)visi')n wi 11 Y'11:,t be erlfIJ'r'ced after t~.,o (2) <br />